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Rethinking Unprotected Sex for HIV-Positive Men

By Mina Kim

Deon Brimmer, 32, is HIV positive and expecting a daughter.  He’s being treated by a new San Francisco program that helps men with HIV safely realize their dreams of being dads. (Photo: Ryan Anson)

Deon, 32, is HIV positive and expecting a daughter. He’s being treated at a new San Francisco program that helps men with HIV safely realize their dreams of being dads. (Photo: Ryan Anson)

The public health message around unprotected sex for those with HIV has always been the same: Don’t do it. Even with huge strides in medical science that’s changed HIV from a death sentence to a chronic but manageable disease, that directive has not changed.

Now, a new program based in San Francisco is challenging this long-held campaign, and helping HIV-positive men have babies — the conventional way. The program run by San Francisco General Hospital, called PRO Men, teaches men about a range of reproductive options, from adoption to in vitro fertilization — where an egg is fertilized in a lab dish — to carefully timed intercourse.

“I would say as an HIV provider community, we have really failed these men,” says UCSF professor Deborah Cohan, who runs the hospital’s Bay Area Perinatal AIDS Center or BAPAC. “We really have not created programs to help them realize those goals and do so safely.”

“It is one of the last big remaining hurdles that I think many heterosexual men and women have to what they would consider living a normal, ordinary life.”

With the discovery of drugs to treat the virus, Cohan said people with HIV are living long, healthy lives. And for those who want to start families, having “safe” sex, Cohan said, can mean foregoing condoms when a female partner is ovulating. Women can also take HIV drugs, which some studies show can protect against the virus. (BAPAC has helped HIV-positive women who adhere to their medications have healthy babies for years.)

“We know that if the person who is positive takes antiretrovirals and their viral load is suppressed, meaning the medication is working at killing all the HIV in the blood, that the likelihood of them passing HIV to a sexual partner is essentially zero,” Cohan said.

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